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Dr. Caren Cajares is a CRNA currently practicing independently in the seven cities that make up
Tidewater, VA. She provides anesthesia services for plastic surgeons, gastroenterologists,
ophthalmologists, oral surgeons, and partners with a dentist in a specialized practice. She is a
veteran of the United States Army, which she includes among her greatest
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Mary Frances Mullins DNP CRNA graduated in June 2016 from Grand Canyon University with her Doctor of Nursing Practice (DNP) degree. In 2001, she graduated from the Uniformed Services University in Bethesda with an MSN in nurse anesthesia. She also holds CPAN and CAPA certification and currently works at Memorial Medical Center in Modesto, CA

Abstract
Nearly 25 million people in the United States suffer from obstructive sleep apnea (OSA). This serious under-recognized, under-diagnosed medical disorder is associated with significant comorbidities as well as increased perioperative risks. Therefore, preoperative screening for OSA using a validated OSA screening tool such as the STOP-Bang OSA screening questionnaire is imperative. Using a quantitative methodology with a comparative design, this author observed for statistically significant differences in the proportion of postoperative hypoxemia between two sample groups. Group A (n=100) was comprised of adult (ages 18-75) general anesthesia elective surgery patients who were screened preoperatively for OSA on the STOP-Bang OSA screening instrument. Group B (n=100) was comprised of adult (ages 18-75) general anesthesia elective surgery patients who were not screened preoperatively for OSA on the STOP-Bang OSA screening instrument. A Chi-square analysis was conducted comparing the proportion of positive postoperative hypoxemia occurrences in the Post Anesthesia Care Unit (PACU). The proportion of patients who experienced hypoxemia in the PACU pre implementation of the STOP-Bang screening program was not equal to the proportion of patients who experienced hypoxemia in the PACU post implementation of the program, χ2 (1, N = 94) = 2.085, p = .149. This was statistically nonsignificant, but clinically relevant. Clinician awareness of the potential existence of OSA can guide the perioperative care plan to safely meet the special needs of surgical patients with OSA.

Table 1. Descriptive Statistics of Demographic Variables.................................................. 70
Table 2. Pearson Chi-Square Goodness of Fit Between Implementation of the STOP-Bang Screening Program and Proportion of Patients who Experience Hypoxemia in the PACU................ 73

Mark Giles, DNP, CRNA is a 2016 graduate of Quinnipiac University, Hamden, Connecticut, post master's program. He is a staff CRNA at Yale New haven Hospital, New Haven, Connecticut, and an adjunct faculty member at Quinnipiac University.

This is the final submission of National University's Jonathan Gardner's Scholarly Project. He is a Nurse Anesthesia Resident at National University.

In Adult Patients Undergoing Total Knee Arthroplasty How Does The Adductor Canal Block As Compared To The Femoral Nerve Block Affect Postoperative Morbidity?

Abstract:

By the year 2030 the demand for primary total knee arthroplasty (TKA) is projected to grow by 673% to 3.48 million procedures. The anesthetic management for TKA has profound and distinct effects on recovery and rehabilitation, with multiple anesthetic options available for perioperative management. We set out to answer the question “In adult patients undergoing total knee arthroplasty how does the adductor canal block as compared to the femoral nerve block effect postoperative morbidity?”

A comprehensive review of the literature was conducted for comparing adductor canal block (ACB) to femoral nerve block. One meta-analysis, 8 randomized controlled trials and 3 retrospective cohort studies were included with a date range from 2013-2015. Current literature demonstrates that adductor canal blocks are equal to, if not superior
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The shoulder joint is the most flexible joint in the human body; therefore, it is more susceptible to injury than others.1 Surgical interventions may sometimes be performed depending on the nature of the injury. A comprehensive analysis of the epidemiology of shoulder surgeries is beyond the scope of this report. Moreover, the variations in shoulder surgeries based on the type of injury being corrected, the facility setting, and reimbursement
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Over the years many Anesthesiologist Assistants (AAs) have contacted us about a possible AA to CRNA bridge program. Though this option does not currently exist the idea has been bantered around the CRNA community now for many years and the discussion is often
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This last week the Vice President and Executive Editor of Audio Digest, Lon Osmond sent out a letter which angered and disenfranchised 50,000 Nurse Anesthetists. The letter was an apology to Physician Anesthesiologist
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Playing with iPads before surgery could replace sedatives for children. Researchers in France who measured the effect of iPads on child and parent anxiety prior to administering anesthesia to the children
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Historically, in some settings, publications, policies and law, the Certified Registered Nurse Anesthetist (CRNA) has been referred to as a “midlevel provider” or “physician extender.” These and other terms are
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An anesthesiologist recently received a several-year prison sentence for prescribing controlled substances without a legitimate medical reason. One of this physician’s patients died from taking hydrocodone, which the physician had prescribed for no legitimate medical purpose.

This is an extreme case involving criminal behavior. Still, any allegation of Medicare or Medicaid fraud or abuse surely ranks at the top of anyones list of nightmare scenarios. It behooves providers and anesthesia
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The patients were lined up in reclining chairs, waiting their turns. When the surgery center’s anesthesiologist reached her, Kathleen White yelped in pain as he injected a numbing agent into her left eye. An assistant whisked her into the operating room for her scheduled cataract surgery.

The surgery lasted no more than 15 minutes — her surgeon had 45 cases on the schedule that day — and seemed to go smoothly. But at a follow-up appointment the next day, a staffer removed the patch over White’s eye and told her to read the letters on a wall chart.

Intellectual dishonestly is something one would not expect from a well respected Physician Society such as a the American Society of Anesthesiologist or the well respected anesthesia magazine Anesthesiology News. Unfortunately it has become all too common and the most recent example is in the press release by the ASA in Anesthesiology News found here only further
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A Philadelphia doctor was arraigned Wednesday in a Montgomery County Court on charges that he illegally provided drugs for more than a year to a woman he met on a "sugar daddy" website, prosecutors said.

A former Kaiser Permanente anesthesiologist has filed a $9 million lawsuit against the health organization, claiming he was fired after he repeatedly complained that cost-cutting measures were jeopardizing the safety of patients in the Portland area.Among those measures was
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A DeKalb County jury has awarded a $4.3 million verdict to the two surviving children of a woman who died of massive internal bleeding after surgery.

The award represents a record verdict reported in a wrongful-death case in DeKalb County. On Oct. 18, 2010, Gloria J. Ormond, 57, went to Kishwaukee Community Hospital in DeKalb. She underwent laparoscopic surgery for a hiatal hernia.

Today on the "Student Doctor Network" in THIS thread you can read about a soon to be CA3 (that is the final year of the 3 year anesthesia residency) talking about his inadequate training. What is especially interesting is that other Physician Anesthesiologists on the same thread are mostly telling this resident it is "ok" and you can get the skills later.

Scope of practice (SOP) restrictions and physician supervision requirements for nurse anesthetists have no impact on anesthesia patient safety, according to new research published in the June 2016 issue of the independent,
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Expand Veterans Access to Quality Healthcare NOW and Help Us Help out Veterans!

Veterans Administration Publishes Proposed Rule Recognizing Veterans Health Administration CRNAs, APRNs to their Full Practice Authority. This Long-awaited action triggers 60-day public comment period; All Veterans, their families and those who care about our military Personnel AND Veterans are urged to
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